血造干细胞移植后的限制性呼吸系统缺陷与增加的死亡率有关
Mansour Alkhunaizi1, Felipe Soto-Lanza2, Cheuk Hong Leung3
1Department of Pulmonary, Allergy and Critical Care Medicine, Stanford Health Care, Stanford, California.
Transplantation and cellular therapy
|February 8, 2025
概括
在血液细胞移植 (HCT) 后出现新的限制性呼吸系统缺陷 (RVD) 显著增加了死亡率. 积极的肺功能监测对于改善HCT接受者的结果至关重要.
科学领域:
- 血液学 血液学 血液学
- 肺部病理学 肺部病理学
- 在瘤学瘤学.
背景情况:
- 血造细胞移植 (HCT) 为血液性恶性瘤提供了潜在的治疗方法,但由于移植后的问题而复杂化.
- 肺部并发症,特别是限制性呼吸器缺陷 (RVD),是一个重大挑战,但其HCT后的流行病学仍未得到充分研究.
研究的目的:
- 调查HCT后新发性RVD的发生率,原因和对整体存活率 (OS) 和非复发性死亡率 (NRM) 的影响.
主要方法:
- 针对血液恶性瘤进行首次异质性HCT的成年患者的回顾性审查.
- RVD的定义:总肺容量 (TLC) <正常的下限的第五百分位.
- 使用卡普兰-梅尔,日志等级测试和考克斯回归模型进行分析.
主要成果:
- 在3030名患者中,有270名患者在HCT后出现了新发的RVD.
- 常见的原因包括呼吸道感染 (23%),间歇性肺病 (15%) 和骨干硬化症 (11%).
- 多变量分析确定了年龄增加,无血缘关系的捐赠者,不匹配的相关捐赠者,带血源,先前存在的RVD和慢性GVHD作为死亡风险因素. 更严重的RVD,渐进的RVD和早期发病 (<1年) 显著增加了死亡率.
结论:
- 在HCT后新发的RVD是增加死亡率的重要独立预测因素.
- 积极的肺功能监测对于早期识别RVD和改善HCT后结果至关重要.
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